School Nurse Resources

New immunization requirements mandated by the PA Dept. of Health for school students: Updated 3/1/2017

FOR ATTENDANCE IN ALL GRADES CHILDREN NEED THE FOLLOWING:

-4 doses of tetanus, diphtheria, and acellular pertussis (1 dose on or after the 4th birthday)*

-4 doses of polio (4th dose on or after 4th birthday and at least 6 months after previous dose given)**

-2 doses of measles, mumps, rubella***

-3 doses of hepatitis B

-2 doses of varicella (chickenpox) or evidence of immunity

*Usually given as DTP or DTaP or if medically advisable, DT or Td

**A fourth dose is not necessary if the third dose was administered at age 4 years or older and at least 6 months after the previous dose

***Usually given as MMR

ON THE FIRST DAY OF SCHOOL, unless the child has a medical/religious/philosophical exemption, a child must have had at least one dose of the above vaccinations or risk exclusion.

-If a child does not have all the doses listed above, needs additional doses, and the next does is medically appropriate, the child must receive that dose within the first five days of school or risk exclusion. If the next dose is not the final dose of the series, the child must also provide a medical plan (red & white card) within the first five days of school for obtaining the required immunizations or risk exclusion.

-If a child does not have all the doses listed above, needs additional doses, and the next dose is not medically appropriate, the child must provide a medical plan (red & white card) within the first five days of school for obtaining the required immunizations or risk exclusion.

-The medical plan must be followed or risk exclusion

FOR ATTENDANCE IN THE 7TH GRADE:

-1 dose of tetanus, diphtheria, acellular pertussis (Tdap) on the first day of 7th grade.

-1 dose of meningococcal conjugate vaccine (MCV) on the first day of 7th grade.

ON THE FIRST DAY OF 7TH GRADE, unless the child has a medical or religious/philosophical exemption, a child must have had the above vaccines or risk exclusion.

FOR ATTENDANCE IN THE 12TH GRADE:

-1 dose of MCV on the first day of the 12th grade. If one dose was given at 16 years of age or older, that shall count as the twelfth grade dose.

ON THE FIRST DAY OF 12TH GRADE, unless the child has a medical or religious/philosophical exemption, a child must have had the above vaccines or risk exclusion.

**The vaccines required for entrance, 7th grade, and 12th grade continue to be required in each succeeding school year.

These requirements allow for the following exemptions: medical reason, religious belief, or philosophical/strong moral or ethical conviction. Even if your child is exempt from immunizations, he or she may be excluded from school during and outbreak of vaccine preventable disease.

Pennsylvania’s school immunization requirements can be found in 28 Pa.CODE CH.23 (School Immunization). Contact your healthcare provider or call 1-877-PA-HEALTH for more information.

FOOD ALLERGIES

Often when people think of allergies they think of those that cause hay-fever symptoms–itchy, watery eyes, runny nose, sneezing…relatively minor symptoms. In contrast, some may recall hearing of a person being rushed to the ER to be treated for a bee-sting. This type of serious allergic reaction is called anaphylaxis. Anaphylaxis is a serious allergic reaction that is rapid in onset and may cause death if not treated promptly and properly. The common causes of anaphylaxis are food, medication, insect stings, and latex. Food allergy is believed to be the leading cause of anaphylaxis causing an estimated 30,000 emergency department visits each year in the U.S. Symptoms of anaphylaxis include hives, wheezing, difficulty breathing, swelling of the mouth and throat area, vomiting, diarrhea, cramping, a drop in blood pressure, and loss of consciousness.

Allergic reactions to foods vary among students and can range from mild to severe life threatening anaphylactic reactions. Some students, who are very sensitive, may react to just touching or inhaling the allergen. The severity of a reaction is not predictable. Because there is a cumulative effect from past exposures to an allergen, the severity of a future exposure cannot be predicted.

Peanut and tree nuts account for 92% of severe and fatal reactions, along with fish and shellfish.

In order to protect students in our school with food allergies, we avoid the eating of food allergens in the classrooms. A letter is sent home informing the parents of other children in the class which foods are safe foods for snacks and parties in the classroom. If a food item with a possible food allergen comes to school for a party, the class holds the party in the cafeteria, to prevent the exposure in the classroom.

MRSA

MRSA is a strain of staph bacteria that does not respond to penicillin or related antibiotics, though it can be treated with other drugs. Left untreated, MRSA can be serious. The infection can be spread by skin-to-skin contact, through openings in the skin such as cuts and abrasions, or through sharing an item, like a towel or a piece of sports equipment, which has been used by an infected person, particularly one with an open wound. MRSA skin infections are generally minor and first appear as pimples, boils or other similar skin conditions.

The following are tips from the Pennsylvania Department of Health and the Centers for Disease Control to help prevent the spread of MRSA and other infections or diseases:

Regular handwashing is the best way to prevent getting and spreading staph/MRSA. Use soap and water or an alcohol-base hand sanitizer. Experts suggest that you wash your hands for as long as it takes you to recite the alphabet.

Practice good skin care. Since staph infections begin when staph enters the body through a break in the skin, keeping skin healthy and intact is an important preventative measure.

Cover cuts and scrapes with a clean bandage to help the wound heal and prevent from spreading bacteria to other people. Be sure to take daily showers with soap and water.

Do not touch other people’s wounds or bandages.

Do not share personal items like towels, razors, toothbrushes, or footwear.

If you use any shared gym equipment, wipe it down before and after you use it.

Daily laundering of personal articles and hot drying of clothes, sheets, and towels.

Encourage those infected to always keep draining lesions covered with dressings and dispose of dressings containing pus and blood carefully.

www.mayoclinic.com/health/mrsa/ID00049 is a web site with information for student athletes

DENTAL

The PA School Code requires all children students in first, third, and seventh grades to have a dental examination. This dental examination can be done by your family dentist or done by the school dentist (at no cost) during the school year. Click here for more information.

PHYSICALS

The PA School Code requires all children entering school for the first time (Ready-4 or Kindergarten) and students in sixth and eleventh grades to have a physical examination. Click here for more information.

SCREENINGS

All students receive yearly height and weight screenings. Click here for more information.

MEDICATIONS

It is preferable that medications be given out of school hours (before or after.) If it is necessary that a child receive medication during the school day, the medication must be delivered to the school by the parent/ guardian (the child cannot bring the medication in his backpack, and cannot bring it on the bus) so that a medication permission form can be signed. Parents are encouraged to bring emergency medications in to school on the first day (EpiPens, inhalers, etc) so that they are available for the child if needed. Medication permission forms (to be signed by the parent/ guardian and the health care provider) can be obtained at the school office, nurse’s office, or down loaded by clicking on the icon below.

Ugh! My favorite part of being a school nurse! Not really; but since children in school do interact closely with one another, head lice is something that we do have to deal with from time to time. You have heard it before, but truly, getting head lice is no reflection on a child’s or family’s cleanliness. It can passed from student to student as easily as pink eye, strep throat or chicken pox. The key to successfully being clear of head lice is being meticulous in combing out the eggs (nits) and daily checking for two weeks following a treatment. Laundering, vaccuuming, and following the directions for the hair shampooing are also essential. Attached you will find a guide to follow in the event that you need to deal with head lice. It is greatly appreciated when parents notify the school nurse if their child has contracted head lice. A screening of the other classmates can be done to try to determine the source. If your child would be found to have head lice during a screening, you will be notified. Please don’t panic, or cry! I will show you what you are looking for, and talk you through the treatment and cleaning process. I will then recheck your child after you have done a treatment and combed through, removing the nits, to be sure that your child can return to class. Children cannot return to school riding the school bus until they have been cleared by the school. Call to be sure the nurse will be in the building at the time you are coming in with your child to be checked

COMMUNICABLE DISEASES

We often have inquiries concerning communicable diseases. This guide may provide the information you need however if you should have additional questions, please do not hesitate to contact the school or your family physician. It is greatly appreciated when parents contact the school when their child has contracted a communicable disease. It is important that children not return to school while still contagious.

CHICKEN POX (Varicella): Child is contagious 1-2 days before onset of rash. Must be kept out of school five days after the appearance of the first crop of vesicles or when all lesions have dried and crusted over. Inform the school as cases are reported to the Department of Health. Children with shingles should follow the same guidelines for returning to school

FIFTH DISEASE: This a mild viral infection spread by contact with respiratory secretions. Symptoms include the “slapped cheek” appearance of the face. A lacy rash over the body also present, which fades in some areas and reappears in others. Usually no fever or low grade. No treatment is indicated. Duration of the rash may be prolonged. May return to school if no fever is present.

HAND, FOOT, MOUTH DISEASE (Coxsacie A virus): A virus that may cause fever, mildly painful ulcers in the mouth, and/or small water blisters or red spots on the palms of the hands, soles of the feet, between the fingers and toes, and buttocks (usually 5 or fewer blisters per extremity). Mainly occurs in children 6 months-4 years of age. May return to school if no fever is present.

HEAD LICE (Pediculosis): See section on web page regarding head lice.

IMPETIGO: A bacterial skin disease caused by strep or staph. Blister-like lesions that quickly develop into crusted sores which are irregular in outline. Requires antibiotic treatment, may return after treament has begun or when judged to be noncontagious.

MENINGITIS: Bacterial infection of the membranes covering the brain and spinal cord. Symptoms may include: sudden onset of fever, nausea, vomiting, intense headache, drowsiness, and pain/stiffness of neck and back. SEEK MEDICAL ATTENTION without delay. Child will be excluded from school until physician releases the child to return. All cases must be reported to the PA State Health Department.

PINK EYE-(Conjunctivitis-bacterial or viral): If bacterial, exclude from school for 24 hours after starting appropriate medication (antibiotic) and until pus-like discharge has stopped.

RINGWORM: A fungal infection of the skin commonly found on the scalp, feet, trunk, face, limbs, and genital areas. Appears as a round, reddened lesion with raised border which clears in the center as it enlarges. You should consult a doctor. May return to school after treatment has begun.

SCABIES: Intensely itchy skin rash caused by a mite. Child must be excluded from school and must be seen by a doctor to obtain effective treatment and permission to return to school.

STREPTOCOCCAL SORE THROAT (including scarlet fever): Symptoms include headache, fever, sore throat, vomiting, and enlarged lymph nodes. With scarlet fever, a fine red rash most often on neck and chest lasts 1-10 days. When it fades, the skin peels in scales. Early recognition and adequate treatment are important to prevent complications such as rheumatic fever. May return to school 24 hours after the appropriate treatment or remain home for 10-21 days in untreated cases.

HEALTH CONCERNS

Please contact the school with updates regarding your child’s health status i.e. surgeries, medications, allergies, illnesses, new diagnoses and other conditions that may affect your child’s school performance. Also inform the school with changes in contact telephone numbers so that you can be promptly reached if there is a problem.

Immunizations

New immunization requirements mandated by the PA Dept. of Health for school students: Updated 3/1/2017

FOR ATTENDANCE IN ALL GRADES CHILDREN NEED THE FOLLOWING:

-4 doses of tetanus, diphtheria, and acellular pertussis (1 dose on or after the 4th birthday)*

-4 doses of polio (4th dose on or after 4th birthday and at least 6 months after previous dose given)**

-2 doses of measles, mumps, rubella***

-3 doses of hepatitis B

-2 doses of varicella (chickenpox) or evidence of immunity

*Usually given as DTP or DTaP or if medically adcisable, DT or Td

**A fourth dose is not necessary if the third dose was administered at age 4 years or older and at least 6 months after the previous dose

***Usually given as MMR

ON THE FIRST DAY OF SCHOOL, unless the child has a medical/religious/philosophical exemption, a child must have had at least one dose of the above vaccinations or risk exclusion.

-If a child does not have all the doses listed above, needs additional doses, and the next does is medically appropriate, the child must receive that dose within the first five days of school or risk exclusion. If the next dose is not the final dose of the series, the child must also provide a medical plan (red & white card) within the first five days of school for obtaining the required immunizations or risk exclusion.

-If a child does not have all the doses listed above, needs additional doses, and the next dose is not medically appropriate, the child must provide a medical plan (red & white card) within the first five days of school for obtaining the required immunizations or risk exclusion.

-The medical plan must be followed or risk exclusion

FOR ATTENDANCE IN THE 7TH GRADE:

-1 dose of tetanus, diphtheria, acellular pertussis (Tdap) on the first day of 7th grade.

-1 dose of meningococcal conjugate vaccine (MCV) on the first day of 7th grade.

ON THE FIRST DAY OF 7TH GRADE, unless the child has a medical or religious/philosophical exemption, a child must have had the above vaccines or risk exclusion.

FOR ATTENDANCE IN THE 12TH GRADE:

-1 dose of MCV on the first day of the 12th grade. If one dose was given at 16 years of age or older, that shall count as the twelfth grade dose.

ON THE FIRST DAY OF 12TH GRADE, unless the child has a medical or religious/philosophical exemption, a child must have had the above vaccines or risk exclusion.

**The vaccines required for entrance, 7th grade, and 12th grade continue to be required in each succeeding school year.

These requirements allow for the following exemptions: medical reason, religious belief, or philosophical/strong moral or ethical conviction. Even if your child is exempt from immunizations, he or she may be excluded from school during and outbreak of vaccine preventable disease.

Pennsylvania’s school immunization requirements can be found in 28 Pa.CODE CH.23 (School Immunization). Contact your healthcare provider or call 1-877-PA-HEALTH for more information.